环泊酚和丙泊酚在老年患者纤维结肠镜治疗中镇静效果比较

目的比较环泊酚和丙泊酚在老年患者纤维结肠镜治疗中的镇静效果。方法选择行纤维结肠镜治疗的老年患者330例,男179例,女151例,年龄65~84岁,BMI 18~29 kg/m^(2),ASAⅠ或Ⅱ级。随机分为两组:环泊酚组(C组,n=160)和丙泊酚组(P组,n=162)。C组麻醉诱导给予环泊酚0.4 mg/kg,麻醉维持泵注环泊酚1~1.5 mg·kg^(-1)·h^(-1),P组麻醉诱导给予丙泊酚2 mg/kg,麻醉维持泵注丙泊酚4~6 mg·kg^(-1)·h^(-1)。记录镇静成功率、诱导时间、完全清醒时间,麻醉诱导前(T_(0))、进镜时(T_(1))、进镜后10 min(T_(2))、完全清醒时(T_(3))时SBP、DBP、BIS,术中心动过缓、低血压、低氧血症、注射痛、体动,气道干预、术中追加镇静和术后恶心呕吐发生情况。结果与P组比较,C组T_(2)时SBP、DBP明显升高(P<0.05),T_(2)和T_(3)时BIS明显降低(P<0.05),术中低氧血症和注射痛发生率明显降低(P<0.05)。两组镇静成功率、诱导时间、完全清醒时间,术中心动过缓、低血压、体动发生率,气道干预、术中追加镇静和术后恶心呕吐发生率差异无统计学意义。结论与丙泊酚比较,环泊酚在老年患者纤维结肠镜治疗中有同样的镇静效果,且有着更低的低氧血症和注射痛发生率,值得临床推广。

Tulip bundle technique and fibrin glue injection:Unusual treatment of colonic perforation

We report a case of a 63-year-old male who experienced an iatrogenic sigmoid perforation repaired combining three endoscopic techniques.The lesion was large and irregular with three discrete perforations,therefore,we decided to close it by placing one clip per perforation,and then connecting all the clips with two endoloops.Finally we chose to use a fibrin glue injection to obtain a complete sealing.Four days after the colonoscopy the patient underwent a laparoscopic right hemicolectomy due to evidence of a large polyp of the caecum with high grade dysplasia and focal carcinoma in situ.Inspection of the sigma showed complete repair of the perforation.This report underlines how a conservative approach,together with a combination of various endoscopic techniques,can resolve complicated iatrogenic perforations of the colon.